PAEDIATRIC FOOT AND ANKLE DISORDER

02 Nov PAEDIATRIC FOOT AND ANKLE DISORDER

Common conditions

• Calcaneovalgus
• Congenital vertical talus
• Club foot. (CTEV)
• Increased femoral anti version
• Internal tibial torsion
• Metatarsal adductus
• out-toeing
• Toe walking

Calcaneovalgus

• Common acquired condition as a result of intrauterine positioning of foetus.
• Characterized by hind foot dorsiflexion and eversion with spasticity of dorsiflexors and evertors whereas weakness of plantar flexors and invertors
• Treatment is usually stretching and observation.

Epidemiology and pathophysiology

• 1 in 1000 live births
• female > male
• due to malpositioning of foot in intrauterine life.
• Clinically mimics congenital vertical talus
• Associated with posteromedial tibial bowing
• Excessive dorsiflexion of the foot to an extent that dorsal surface is touching or almost touching the shin to tibia which is correctable passively.

Imaging

• X-ray of tibia including ankle and foot in AP and lateral views TO LOOK FOR POSTEROMEDIAL BOWING
• Plantar flexion lateral views of the ankle e and foot to rule out CONGENITAL VERTICAL TALUS.
• A line passing through the talus should pass through the 1 metatarsal but in congenital vertical talus line passes plantar to the navicular and 1st ray
• Differential diagnosis Posteromedial tibial bowing, congenital vertical talus, Paralytic foot

Treatment

• Gentle stretching and casting
• Deformity corrects by 18 months
• Tibial bowing corrects by 7 years
• COMPLICATION : Limb length discrepancy